Fill - Free fillable 2019-2020 Dependency Override Request Form (Berkeley City College) PDF form

Financial Aid

Office

2019-2020 Dependency Override Request Form

The Department of Education determines a student’s status as dependent or independent by the answers the

students provides on the Free Application for Federal Student Aid (FAFSA). To be considered independent of

your parents for financial aid purposes, you must prove that one of the following is true:

• Be born before January 01, 1996; or

• Be a graduate or professional student; or

• Be married on the day you apply for financial aid (being separated still counts as being married); or

• You have children who receive more than half of their support from you; or

• You have dependents other than children who live with you and receive more than half of their support

from you; or

• You are an orphan (both parents are deceased); or

• You were a ward of the court until age 18 or were a foster child after the age of 13; or

• You were/are in legal guardianship; or

• You were /are an emancipated minor; or

•

You are an accompanied youth who was homeless or at risk of homelessness on or after July 1, 2018; or

• You are serving a

ctive duty in the U.S. Armed Forces (other than training) or a U.S. Armed Forces

veteran; or

• You have special and unusual extenuating circumstances that can be DOCUMENTED for your financial aid

administrators, who may then request a “dependency override” on the FAFSA appli

cation.

(NOTE: Exceptions are granted very rarely and only in extreme cases.)

If NONE of the above criteria apply to you, you are a DEPENDENT student.

IMPORTANT:

Many students feel that they should be able to declare INDEPENDENT status because they live on their own, file

their own taxes, or receive no support from their parents, but those reasons will not constitute as extenuating

circumstances to merit a dependency override. Unfortunately, the Department of Education is extremely strict

with regard to determining dependency status.

DIRECTIONS:

After reading the information above carefully, if you feel you can substantiate an

extenuating circumstance, then complete this form and the Third Party Verification Form and submit it to

THE FINANCIAL AID COMMITTEE DECISION IS CONSIDERED FINAL AND CANNOT BE APPEALED

Rev. 3/15/2019

the F

inancial Aid Office (FAO). Your request will be reviewed by the FAO. Committee.

(Dependency Override Form - Please answer ALL of the following questions:)

Biological MOTHER

Deceased : Yes ( ) No ( ) Don’t Know ( ) FATHER Deceased : Yes ( ) No ( ) Don’t Know ( )

Parents

Name: _____________________________________ _______________________________________

Address: _____________________________________ _______________________________________

_____________________________________ _______________________________________

Phone #: _________________________________ ___________________________________

When was the last time you lived with your Mother? ______________ With your Father?_____________

Month / Year Month / Year

. When was the last time you had contact with your Mother? __________ With your Father?___________

Month / Year Month / Year

. When did your Mother last provide support? ______________________ Your Father?_______________

Month / Year Month / Year

What are your present living arrangements (Who do you live with? How much do you pay each month for

Rent? When did this arrangement begin?)

______________________________________________________________________________________

5. How do you support yourself and meet your current living expenses?

_____________________________________________________________________________________

______________________________________________________________________________________

6. Why are your parents no longer able to support you? Explain in detail the circumstances involving your

parents inability or unwillingness to support you. Attach a separate sheet of paper if necessary to provide

additional information that you feel supports your request to be considered as an independent student.

______________________________________________________________________________________

FOR OFFICE USE ONLY: Using Professional Judgment, this Student is:

Independent______ Dependent _______

STUDENT:

Last Name:___________________________ First Name:_______________________ Contact Phone# : _____________________

Student ID#: ______________________ SSN (Last 4-digits): ____________

Date of Birth: _______/______/_________

Address: _______________________________________________________________________________________________________________

Street City State Zipcode

I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AND I UNDERSTAND THAT IT MAY BE

USED TO OVERRIDE FEDERAL REGULATIONS REGARDING MY DEPENDENCY STATUS. IF I PURPOSELY GIVE

FALSE OR MISLEADING INFORMATION ON THIS FORM, I MAY BE FINED $10,000, SENT TO PRISON, OR BOTH.

_____________________

_________________________ ____________________

Student Signature

Date

Comments:_____________________________________________________________________________

_____________________________________________________________________________________

Rev. 3/15/2019

Financial Aid and

Scholarship Office

Third Party Verification

To The Student: PLEASE GIVE THIS FORM TO THE THIRD PARTY PROFESSIONAL SUCH AS COUNSELORS,TEACHERS,

CLERGY, COMMUNITY GROUPS, GOVERNMENT AGENCIES, MEDICAL PERSONNEL, COURTS, OR POLICE OFFICER/

ADMINISTRATORS WHO HAVE KNOWLEDGE OF THE UNUSUAL CIRCUMSTANCES OF YOUR SITUATION. HAVE THE THIRD

PARTY REPRESENTIVE COMPLETE THE WRITTEN VERIFICATION FORM WITH AN OFFICIAL LETTERHEAD OR SUBMIT AN

OFFICIAL BUSINESS CARD ALONG WITH THIS FORM.

STUDENT NAME:__________________________________STUDENT ID#:_____________________Date of Birth:________________

Please describe the above named student’s home situation with his/her parents in enough detail so then the

financial aid office may determine if there is an adverse home situation. (attach additional sheet if

necessary and be sure to sign statement and attachments)

_______________________________________________________________________________________________________________________________

_____________________________

I Certify that the above statement is true and correct to the best of my knowledge. I

understand that I may be contacted by a financial aid administrator for verification of

information.

_____________________________________________________

Third Party Signature

__________________________

Date

____________________________________________________ ___________________________

Third Party Name Printed Contact Telephone Number

___________________________________________________ ______________________________________________________

Address City State Zip Code

__________________________________________________________ ____________________________

Relationship to Student Length of time Known Student

Rev. 3/15/2019

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